‘Passionate strategy needed to mitigate malnutrition due to lockdown’

India has the biggest number of malnourished children globally. Policy makers have been devising plans to eradicate malnutrition and ensure children grow healthy. However, the novel coronavirus disease (COVID-19) pandemic has created turmoil and there are chances that the country could lose what it had gained in the last few years.

Experts are trying to understand how the ongoing crisis can impact child health. Down To Earth spoke to William Joe from the Population Research Centre, Institute of Economic Growth, Delhi and SV Subramanian from the Department of Social and Behavioural Sciences, Harvard TH Chan School of Public Health, Boston, United States, for their perspective. Edited excerpts:

Kundan Pandey: You have talked about children who are on the threshold of malnutrition in your research. Do you think we need fresh data on their population?

William Joe and SV Subramanian: At this point, we have data on the height / weight of children provided by the 2016 National Family Health Survey (NFHS). So, an immediate rapid assessment of nutritional status is needed.

We have tried to show that while conventional outcomes of nutritional failures are based on dichotomised classification, they fail to capture the magnitude of children marginally above / below the cut-off point. We have also tried to show how small shocks can tip a child into a ‘clinically’ deprived state.

We exemplified using the older NFHS data but the real situation might be grimmer if the health, economic and food system impact is severe. The same applies for severely malnourished children as well. Therefore, at the policy level, it is crucial to take cognisance of these children through rapid surveys and assessment while targeting interventions.

KP: Do you think the current COVID-19 crisis and the lockdown makes these children more vulnerable?

WJ & SVS: Yes, the vulnerability among children from the poorest households is relatively much higher in these current times of distress, particularly after the sudden slump in all economic activities due to the abrupt lockdown.

Indeed, the lockdown is not just about livelihoods or economics but equally about life and lives. The lockdown may have led to the sudden halt in all public health and nutrition interventions such as mid-day school meals or hot cooked meals at anganwadi centres and other supplementary nutrition programs under the Integrated Child Development Services (ICDS).

Clearly, children from those households, who barely survive at subsistence level even in normal days, will suffer an adverse impact on their usual dietary intake and therefore body weight. Services are being resumed but it may take a while to re-attain the pre-lockdown levels.

But, generally speaking, it may be noted that these children are at an elevated risk in normal times as well. In this regard, as mentioned in the study, I would like to stress on the fact that the magnitude of concentration of such children (around standard cut-off) is determined by the usual dietary intake, dietary diversity, socioeconomic environment, maternal health and nutrition status and coverage of nutrition-sensitive and nutrition-related interventions. Hence, it is critical to focus on these children in normal times as well, while targeting interventions.

KP: Do you think India is going to undo the progress it has made in the past decade or so in eradicating malnutrition due to the current crisis?

WJ&SVV: During the past few months, several media reports that highlight the food and nutrition-related challenges, particularly among the poor, have emerged. Given this situation, even a slight loss (as little as 0.5 per cent) in body weight among the poorest children due to lockdown-induced disruptions will undo the gains.

Indeed, in the past couple of years, there was a palpable and real policy momentum in India to improve child nutrition status at political as well as administrative levels. A number of behavioural interventions under the POSHAN Abhiyaan such as Village and Health Nutrition Day must have experienced a setback.

More importantly, diet related shocks and even a temporary pause in delivery nutrition interventions to pregnant women from poor households will further intensify the problem of nutritional failures among new-borns and children in the first 1,000 days.

KP: Your study says that states like Madhya Pradesh, Bihar and Uttar Pradesh will be most affected from the increased number of malnourished children. What could be the possible reason for that? What kind of precaution should these states take?

WJ&SVV: Primarily, the intrinsic demographic and socioeconomic characteristics make these states more vulnerable in terms of magnitude of impact. For example, with the highest child population base, these states may experience the highest absolute number of additional underweight and wasting cases.

Add to this, the high level of poverty head count ratio, high maternal mortality, infant mortality, low coverage of public health and nutrition services like ICDS along with the struggling health care delivery system, it is plausible that states like Uttar Pradesh and Bihar will be most affected. These states already bear a huge burden of child malnutrition. For example, every second child from the poorest household in Bihar is already underweight.

At this point, it is critical to ensure continuous supply of nutritious food and supplementation to children and pregnant women from the poorest families. It is also necessary to immediately restore the main services of anganwadis. Direct cash transfers in the hands of women from the poorest strata could be another effective alternative to mitigate some of the immediate effects.

KP: What is the takeaway from the pandemic and increasing malnutrition?

WJ&SVV: We should be careful in not attributing the disruption of the services to the COVID-19 pandemic itself. It is the national lockdown response launched as a means to contain or mitigate COVID19 that is causing this.

It is not at all clear whether the national lockdown strategy was effective even in containing COVID-19. But it is clear that as a society, we will be paying a considerable cost — in lives (mostly lives of the vulnerable and children) — as a consequence of the strategy we adopted.

At this stage, we need to launch an equally passionate strategy of containing and mitigating problems such as undernutrition that has become far more acute as a consequence of the lockdown. Both cash transfers and in-kind transfers may be necessary in substantial measure.

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